We read the recent article on this subject with interest(1). Reye’s syndrome an acute non-inflamatory encephalopathy is a disease entity known in the field of medicine since 1963, despite which a lot that is known about the disease is yet to be conclusively proven. Many studies have been undertaken to clarify or assert the assumptions about the syndrome; as a result of which it is by now clear that the etiology pattern is not universally similar and a single causative agent cannot be implicated in the etiopathogenisis.

In the above mentioned study(1), the design is well-conceived to estimate the extent of the disease occurrence but the etiologies still remain as presumptious and are not conclusive.

We would like to draw the attention of the authors to another study done on the same subject by the Indian Council of Medical Research in Vani Vilas Hospital in south India(2). One hundred and twenty four cases of Reye’s syndrome admitted to Vani Vilas children’s hospital, Bangalore, during the period of October 1983 to December 1986 were investigated. Clinical, biochemical and epi-demiologic details were obtained. The median age was 5 years with no difference in sex ratio. This disease was frequent in winter months. Cases clustered in certain congested localities of the city among the lower socio-economic strata. Aspirin and varicella could not be associated as preceding factors. The clinical and biochemical features of the patients were suggestive of Reye’s syndrome.

Histopathological evaluation was done in 104 liver biopsy specimens. Virological studies for influenza and Arbovirus were negative. Mortality was high (78%)(2). This study could not establish salicylates as the etiologic agent. The practice of selling salicylates as a over-the-counter drug for fever in children is no longer seen, atleast in the pharmacies of major cities, strongly suggesting against aspirin as a sole putative agent. However, it is wise to be cautious about its valid use in the concerned clinical situations only, for example, rheumatoid arthritis. It is premature to conclude that aspirin is the causative agent by some circumstantial evidence like finding aspirin in the dispensaries of practitioners surveyed.

Further, regarding the viral etiology of Reye’s Syndrome, the study does not mention if viral isolation or serum/CSF serology was the method employed for diagnosis and if it was the latter (CSF serology), was it exclusively positive and if so in how many? To implicate only measles and varicella with the data published would be inadequate.

The study has served to estimate the extent of Reye’s Syndrome and the awareness of the disease among practitioners. It has also created awareness of situations where it is deficient by health education intervention. However, it is still inconclusive about the etiology of the disease.

D.G. Benakappa,
Vanitha J.,

Indira Gandhi Institute of Child Health,
South Hospital Complex,
Dharmaram College Post,
Bangalore 560 029, India.

References

1. Ghosh D, Dhadwal D, Aggarwal A, Mitra S, Garg SK, Kumar R, et al. Investigation of an epidemic of Reye’s syndrome in Northern region of India. Indian Pediatr 1999; 36: 1097-1106.

2. Benakappa DG, Das S, Shankar SK, Rama Rao BSS, George PS, Awasth PS, et al. Reye’s syndrome in Bangalore. Indian J Pediatr 1991; 58: 805-810.